MEDICARE: NEW RAY OF HOPE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	MHL092533	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679614309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW RAY OF HOPE, INC.

Provider Business Mailing Address
First Line	:	1305 HENDREN CIR
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-4937
Country	:	US
Telephone Number	:	678-793-8449
Fax Number	:	770-465-2374

Provider Business Practice Location Address
First Line	:	588 KINGSGATE RDG
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30088-1828
Country	:	US
Telephone Number	:	678-793-8449
Fax Number	:	770-465-2374

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CAROL L. BRPPKS
Credential	:
Telephone Number	:	678-793-8449

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	08/22/2020

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